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Background Current methods for injury registration in sports injury epidemiology studies may substantially underestimate the true burden of overuse injuries due to a reliance on time-loss injury definitions. Objective To develop and validate a new method for the registration of overuse injuries in sports. Methods A new method, including a new overuse injury questionnaire, was developed and validated in a 13-week prospective study of injuries among 313 athletes from five different sports, cross-country skiing, floorball, handball, road cycling and volleyball. All athletes completed a questionnaire by email each week to register problems in the knee, lower back and shoulder. Standard injury registration methods were also used to record all time-loss injuries that occurred during the study period. Results The new method recorded 419 overuse problems in the knee, lower back and shoulder during the 3-month-study period. Of these, 142 were classified as substantial overuse problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Each week, an average of 39% of athletes reported having overuse problems and 13% reported having substantial problems. In contrast, standard methods of injury registration registered only 40 overuse injuries located in the same anatomical areas, the majority of which were of minimal or mild severity. Conclusion Standard injury surveillance methods only capture a small percentage of the overuse problems affecting the athletes, largely because few problems led to time loss from training or competition. The new method captured a more complete and nuanced picture of the burden of overuse injuries in this cohort.

Background Achilles tendon disorders, like Achilles tendinopathy, are very common among athletes. In the general population, however, knowledge about the incidence of Achilles tendinopathy is lacking. Design Cross-sectional study. Methods In a cohort of 57.725 persons registered in primary care, the number of patients visiting the general practitioner (GP) with diagnosis of mid-portion Achilles tendon problems was counted using computerised registration networks of GPs in 2009. Subsequently, the authors assessed associations of these rates with demographic characteristics. Results The incidence rate of Achilles tendinopathy is 1.85 per 1,000 Dutch GP registered patients. In the adult population (21–60 years), the incidence rate is 2.35 per 1,000. In 35% of the cases, a relationship with sports activity was recorded. Conclusion This is the first report on incidence rates of mid-portion Achilles tendinopathy in general practice. With an incidence of 1.85 per 1,000 registered persons, Achilles tendinopathy is frequently seen by GPs. The actual incidence might even be higher due to study limitations. More research on the frequency of this injury is required.

Lateral epicondylitis, also termed as “tennis elbow,” is the most common cause of elbow pain and dysfunction, mainly resulting from repetitive gripping or wrist extension during various activities. The exact pathogenesis remains largely elusive with putative tendinosis, a symptomatic degenerative process of the local tendon. It is usually diagnosed by clinical examinations. Sometimes, additional imaging is required for a specific differential diagnosis. Although most cases can be self-healing, the optimal treatment strategy for chronic lateral epicondylitis remains controversial. This article presents a landscape of emerging evidence on lateral epicondylitis and focuses on the pathogenesis, diagnosis, and management, shedding light on the understandings and treatment for healthcare professionals.

Individuals with patellofemoral pain (PFP) experience pain during various functional activities. Long-term pain is a common consequence of PFP, yet little is known about daily pain variability. Twenty-five individuals with PFP completed the Anterior Knee Pain Scale (AKPS) and recorded daily pain over 10-days. Pain was evaluated by two measures of intensity (baseline pain, 10-day average pain) and two measures of variability (mean square of successive differences [MSSD], probability of acute change [PAC]). Associations between AKPS and the four pain measures were calculated with Pearson correlations. A linear regression was performed to examine the amount of variance in the AKPS explained by the four pain measures. Greater MSSD values were moderately associated with lesser AKPS scores (r =−.648, p<.001). MSSD and 10-day averaged pain was the strongest predictor of AKPS (R2=.565, p<.001). Pain variability provides a unique perspective in the pain experience and predicts patient-oriented function in individuals with PFP.

Purpose To explore and describe therapeutic approaches for the prevention of upper limb (UL) repetitive strain injuries (RSI) amongst computer users in the twenty-first century. Methods A scoping review was conducted using the method described by Arksey and O’Malley, further enhanced by Levac et al. to ensure rigor, validity and reliability during analysis. Key concepts pertaining to the research question have been mapped, following comprehensive searches of relevant electronic databases namely EBSCOHost (Academic Search Premier, CINAHL, eBook Collection, E-Journals, Health Source-Consumer Edition, Health Sources—Nursing/Academic Edition and MEDLINE), PUBMED and Google Scholar. The identified studies have been presented in a descriptive numerical summary to address the research aim. Results From the 577 studies initially identified, 58 studies were eligible for inclusion in the scoping review after abstract and full text screening. Strategies for the prevention of UL RSIs in computer users were categorised into overarching types of intervention as well as the factors which contribute towards sustained implementation of prevention strategies. Using ergonomic equipment was the most prevalent approach during intervention, breaks and rest periods were found to be the less common intervention offered to prevent RSIs. The majority of the studies noted personal worksite adjustments, including adjustments of the chair, back rest, lumbar support, handles or any arm support to the individual as a strategy to prevent UL RSIs. In high income countries the use of ergonomic equipment was the most common type of approach during intervention, in middle income countries stretches were the most common therapeutic intervention strategy and in low-income countries there was an even distribution between a number of different therapeutic interventions aimed at preventing RSIs. Conclusions The review provides an overview of approaches and a comprehensive baseline for identifying further research required to generate prevention approaches. The information within the review may be used to impact company practice, policy and decision making in terms of developing prevention strategies.

Context: Considering current models that highlight the role of psychological components in pain management, mindfulness practice may be an effective strategy in the management of pain.Objective: To examine the effects of adding an eight-week mindfulness program to exercise therapy on the perceptions of pain severity, knee function, fear of movement, and pain catastrophizing of female recreational runners with patellofemoral pain (PFP).Design: Parallel randomized control clinical trial.Setting: University Lab.Patients or Other Participants: Thirty female runners (age 28.3±7.08 years) with PFP were randomly assigned to the two intervention groups: exercise group and mindfulness-exercise group.Intervention(s): The Ex group received 18 weeks (3 sessions per week) of an exercise program for symptoms control and training modifications. The mindfulness-exercise group received an 8-week mindfulness intervention in addition to the exercise program. The mindfulness component started 4 weeks before the exercise component; therefore, the two components overlapped during the first 4 weeks of the intervention.Main Outcome Measure(s): Usual pain, pain during stepping, and pain during running were assessed through visual analog scales (VAS). Functional limitations of the knee were assessed using the knee outcome survey. Fear of movement, pain catastrophizing, and coping strategies were measured with the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Coping Strategies Questionnaire, respectively. These outcomes were assessed at baseline, at week 9, and after 18 weeks.Results: Pain during running, pain during stepping, and functional limitations of the knee were significantly lower for the mindfulness-exercise group than for the exercise group (p<.05). mindfulness-exercise participants reported higher perceived treatment effects than exercise group participants (p<.05). Pain catastrophizing was lower and coping strategies were more favorable for mindfulness-exercise participants than for exercise participants (p<.05).Conclusions: Mindfulness practice can be an effective adjunct to exercise therapy in the rehabilitation of PFP in recreational female runners.Trial Registry: Trial was registered with the (blind).Key Points:Adding an 8-week mindfulness intervention to an exercise therapy program facilitated a quicker onset of perceived therapeutic effectiveness in the terms of clinical and psychological outcomes in runners with PFP.After 18 weeks exercise therapy, participants who received an 8-week mindfulness program showed greater improvements in the clinical and psychological outcomes than those who didn't receive program, indicating better long-term effectiveness.Addition of 8-week mindfulness practice to the PFP exercise therapy program led to more long-lasting effects two months after the completion of the interventions.

Patellofemoral pain (PFP) is prevalent and challenging to manage. Most people with PFP are unsatisfied with their knee function 6-months following treatment, and report ongoing pain up to 16-years after diagnosis. Confidence and knowledge to provide evidence-based care to people with PFP amongst Athletic Trainers (ATs) is currently unknown. Investigate confidence and knowledge of ATs for the treatment, diagnosis, risk factors, and prognosis with current evidence for PFP. Cross-sectional study. Online survey. Patient or Other Participants: A random sample of 3000 ATs were invited to participate; 261 completed the survey (10% participation rate, 88% completion rate). AT demographics, confidence in PFP management, and knowledge related to diagnosis, risk factors, prognosis and treatment were surveyed. Chi-squared analyses assessed responses related to confidence and knowledge to manage PFP. ATs beliefs about evidence was compared to current evidence available (i.e. consensus statements, position statements, systematic reviews). 91% of ATs surveyed were confident that their management of PFP aligns with current evidence, but only 59% were confident in identifying risk factors for PFP development. 91-92% of ATs responded that quadriceps and hip muscle weakness were risk factor for PFP, which aligns with current evidence for quadriceps but not hip muscle weakness. 93-97% of AT responses related to therapeutic exercise aligned with current evidence. However, 35-48% of responses supported the use of passive treatments, such as electrophysical agents and ultrasound, which do not align with current evidence. Most ATs are aware of supporting evidence for therapeutic exercise in PFP management and are confident providing it, providing a strong foundation for evidence-based care. However, varying awareness of evidence related to risk factors and passive treatments for PFP highlights a need for professional development initiatives to better align AT knowledge with current evidence.

Individuals with patellofemoral pain (PFP) experience discomfort during various functional activities. Long-term pain is a common consequence of PFP, yet little is known about daily pain variability. Our study consisted of 25 individuals with PFP who completed the Anterior Knee Pain Scale (AKPS) and recorded their daily pain over 10 days. Pain was evaluated using 2 measures of intensity (baseline pain, 10-day average pain) and 2 measures of variability (mean square of successive differences, probability of acute change). Associations between AKPS and the 4 pain measures were calculated with Pearson correlations. We calculated a linear regression to examine the amount of variance in the AKPS explained by the 4 pain measures. Greater mean square of successive differences values were moderately associated with lesser AKPS scores (r = −0.648, P < .001). Mean square of successive differences and 10-day averaged pain were the strongest predictors of AKPS (R2 = 0.565, P < .001). Pain variability provided a unique perspective on the pain experience and predicted patient-oriented function in individuals with PFP.

Objective: Patellofemoral pain has high recurrence rates and minimal long-term treatment success. Central sensitization refers to dysfunctional pain modulation that occurs when nociceptive neurons become hyper responsive. Research in this area in PFP has been increasingly productive in the past decade. The aim of this review is to determine whether evidence supports manifestations of central sensitization in individuals with PFP.Data sources: MeSH terms for quantitative sensory testing (QST) pressure pain thresholds, conditioned pain modulation, temporal summation, sensitization, hyperalgesia, and anterior knee pain or PFP were searched in PubMed, SportDiscus, CINAHL, Academic Search Complete, and Ebscohost.Study Selection: Peer reviewed studies written in English, published between 2005–2020 which investigated QST and/or pain mapping in a sample with PFP were included in this review.Data Extraction: The initial search yielded 140 articles. After duplicates were removed, 78 article abstracts were reviewed. Full-text review of 21 studies occurred, with 11 studies included in the meta-analysis and eight studies included in the systematic review.Data Synthesis: A random-effects meta-analysis was conducted for four QST variables (local pressure pain thresholds, remote pressure pain thresholds, conditioned pain modulation, temporal summation). Strong evidence supports lower local and remote pressure pain thresholds, impaired conditioned pain modulation, and facilitated temporal summation in individuals with PFP compared to pain-free individuals. Conflicting evidence is presented for heat and cold pain thresholds. Pain mapping demonstrated expanding pain patterns associated with long PFP symptom duration.Conclusions: Signs of central sensitization are present in individuals with PFP, indicating altered pain modulation. PFP etiological and treatment models should reflect the current body of evidence regarding central sensitization. Signs of central sensitization should be monitored clinically and treatments with central effects should be considered as part of a multi-modal plan of care.Registration Number: This review is registered with Prospero (CRD42019127548)Registration URL:https://www.crd.york.ac.uk/PROSPEROPain persistence in patellofemoral pain may be the result of central sensitization.Individuals with PFP demonstrate altered pressure pain thresholds, central pain inhibition, and central pain facilitation compared to pain-free individuals.Clinicians should incorporate quantitative sensory tests into the examination process to track improvement over time.

Background: The effectiveness of platelet-rich plasma (PRP) injection in the treatment of lateral epicondylitis remains debatable. Purpose: To evaluate the effectiveness of PRP in lateral epicondylitis treatment using minimal clinically important difference (MCID) values as a reference and to investigate if leukocyte content can influence the effectiveness of the therapy. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched the Medline and Scopus databases for studies on lateral epicondylitis and PRP therapy that used the following patient-reported outcome measures (PROMs): visual analog scale (VAS) for pain; Disabilities of the Arm, Shoulder and Hand (DASH); Patient-Rated Tennis Elbow Evaluation (PRTEE); and Mayo Clinic Performance Index (MAYO). The weighted arithmetic means for the PROMs were calculated at baseline (week 0) and follow-up weeks 4, 8, 12, 24, 52, and 104. The mean differences in outcomes (ΔVAS, ΔDASH, ΔPRTEE, and ΔMAYO) were compared with the MCID values at each follow-up point. In addition, the effectiveness of leukocyte-rich PRP (LR-PRP) versus leukocyte-poor PRP (LP-PRP) was also compared. The Student t test was used in all analyses. Results: A total of 26 studies were included in the analysis. After PRP injection, all PROM scores improved with time. The scores improved significantly from baseline to each follow-up time (P < .0001), with the exception of the PRTEE (no significant difference at follow-up weeks 12 and 52). The mean difference in scores from baseline exceeded the respective MCIDs from weeks 4 to 104 for the VAS and DASH, from weeks 4 to 52 for the MAYO, and from weeks 8 to 52 for the PRTEE. The MCID for each of the PROMs was exceeded at almost every observation period in both the LR-PRP and the LP-PRP systems. Conclusion: Based on comparisons with the MCID values of commonly used outcome scores, PRP seems to be an effective form of treatment for lateral epicondylitis. Both the LR- PRP and the LP- PRP systems were effective in the context of meeting the MCID.